Metformin Associated Lactic Acidosis (MALA) Pathophysiology of MALA - Metformin interferes with the activity of the Cori cycle, an enzymatic cycle found in the liver that recycles peripheral lactate and converts it into pyruvate & glucose for use in cellular metabolism - At concentrations > 5 μg/mL, metformin binds to complexes of the mitochondrial electron transport chain and inhibits hepatocellular aerobic ATP production increased lactate production via anaerobic metabolism Diagnosis of MALA - Abdominal pain, gastrointestinal distress and acute kidney injury are common at presentation - Clinical presentation also includes symptoms of metabolic acidosis including: - Kussmaul respiration - altered mental status - hemodynamic instability By Dr. Kathryn Watson @Kat_Watson #MALA #Metformin #LacticAcidosis #Toxicity #Toxicology #Diagnosis #Management
